NHS Continuing Healthcare (CHC) can cover nursing or care home fees or the cost of your care at home. Our Community Care Law Team answer questions about NHS Continuing Healthcare and who is eligible
You will qualify for NHS Continuing Healthcare funding if the NHS agree that you have a primary healthcare need. There is no simple definition of what is a primary healthcare need. NHS England publish quarterly statistics that show how few people qualify for NHS continuing care. The latest figures show that only 57,240 adults across England were eligible for NHS CHC. From this total, 35,474 people were eligible for standard NHS CHC. The other 18,766 people had Fast Track funding, sometimes called “NHS end of life care funding”.
Eligibility for NHS continuing care is not based on your diagnosis. It is based on an assessment of whether your needs are of a primary healthcare nature or a social care nature. Some people with Alzheimer’s or Dementia qualify for NHS continuing care but many hundreds of thousands of people do not. This situation is often called “The Dementia Tax”. Many people with long-term conditions have to use up all of their savings and the value of their home paying their social care costs.
Unlike Social Services means tested care, NHS Continuing Healthcare is not means tested. If you qualify for continuing care, the NHS should usually cover the full cost of your care package at home or in a care home.
Not necessarily. Like Social Services, the NHS places a limit on the amount that they will pay for your care. The amount of NHS Care Home funding is based on your assessed needs and not your preferences. The Social Services funding rules give you a legal right to choose a more expensive care home, so long as someone can pay the care home top-up fee. Under the NHS funding rules, you do not have a legal right to choose your care home. The NHS might say that you have to move to a cheaper care home.
The Checklist is a screening tool, which determines whether you should have a full assessment for NHS CHC eligibility. The Checklist is used by Health or Social Services in a number of care settings, often but not always a hospital setting. If you get enough A or B scores in the Checklist then you will move on to the Decision Support Tool assessment stage. Passing the NHS CHC Checklist does not mean you will qualify for NHS care fee funding.
No: this is one of many NHS CHC fake facts. Eligibility for NHS Continuing Healthcare does not depend upon where you receive care. If you qualify for NHS CHC, your care package can be funded in your home, in a care home or in a nursing home.
No: the Clinical Commissioning Group (CCG) CCG will regularly review your eligibility for NHS CHC. The first review is usually held after three months and then you will have annual reviews. The CCGs might withdraw your NHS CHC funding award on the basis that your needs have become stable and routine, so they are social care needs, not healthcare needs. You should always consider appealing a negative NHS CHC decision.
If you need help challenging a decision by Health or Social Services about yours or a family member’s assessed needs, or you disagree with a funding decision made by Health or Social Services, then please contact our Community Care Law Team on 01273 609911, or email firstname.lastname@example.org.
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